| NPI | 1396587317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 95035394) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 95299302) |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2025-09-12 |